Abstract

Background

Maternal mortality in Kenya increased from 380/100000 live births to 530/100000 live
births between 1990 and 2008. Skilled assistance during childbirth is central to reducing
maternal mortality yet the proportion of deliveries taking place in health facilities
where such assistance can reliably be provided has remained below 50% since the early
1990s. We use the 2008/2009 Kenya Demographic and Health Survey data to describe the
factors that determine where women deliver in Kenya and to explore reasons given for
home delivery.

Methods

Data on place of delivery, reasons for home delivery, and a range of potential explanatory
factors were collected by interviewer-led questionnaire on 3977 women and augmented
with distance from the nearest health facility estimated using health facility Global
Positioning System (GPS) co-ordinates. Predictors of whether the woman’s most recent
delivery was in a health facility were explored in an exploratory risk factor analysis
using multiple logistic regression. The main reasons given by the woman for home delivery
were also examined.

Results

Living in urban areas, being wealthy, more educated, using antenatal care services
optimally and lower parity strongly predicted where women delivered, and so did region,
ethnicity, and type of facilities used. Wealth and rural/urban residence were independently
related. The effect of distance from a health facility was not significant after controlling
for other variables. Women most commonly cited distance and/or lack of transport as
reasons for not delivering in a health facility but over 60% gave other reasons including
20.5% who considered health facility delivery unnecessary, 18% who cited abrupt delivery
as the main reason and 11% who cited high cost.

Conclusion

Physical access to health facilities through distance and/or lack of transport, and
economic considerations are important barriers for women to delivering in a health
facility in Kenya. Some women do not perceive a need to deliver in a health facility
and may value health facility delivery less with subsequent deliveries. Access to
appropriate transport for mothers in labour and improving the experiences and outcomes
for mothers using health facilities at childbirth augmented by health education may
increase uptake of health facility delivery in Kenya.